Published online Sep 18, 2023. doi: 10.5312/wjo.v14.i9.707
Peer-review started: April 13, 2023
First decision: July 4, 2023
Revised: August 3, 2023
Accepted: August 21, 2023
Article in press: August 21, 2023
Published online: September 18, 2023
Prefabricated orthotics with arch support provides symptom relief in plantar fasciitis (PF) but are only effective when shoes are worn. Hence, the foot may be left unsupported when it is impractical to wear shoes, such as in the morning or evening at home. Utilising orthotic sandals in conjunction with prefabricated orthotics may enhance symptom relief for PF patients, as they can be worn inside the home, thereby extending the period in which the foot is supported. Prefabricated orthotics and orthotic sandals have been investigated as treatment methods for PF independently, but not in combination.
PF affects around 10% of the population. The resulting pain can cause activity avoidance, disability, and reduced quality of life. However, the natural history of PF is that it resolves naturally with time. Unfortunately, it remains symptomatic during the active phase and requires intervention for pain relief and symptom improvement. As most cases of PF spontaneously resolve with the passage of time, it is needless to burden the already overburdened healthcare system to address this disorder. This trial sought to identify the superiority between two drug-free and non-invasive treatment modalities to address plantar heel pain which can be used as a self-help measure by patients.
To compare the combined use of orthotics and orthotic sandals vs the sole use of orthotics in the treatment of PF.
104 participants were randomly assigned to the intervention group, who received both prefabricated orthotics and orthotics sandals, or the control group, who received prefabricated orthotics only. Participants were instructed to use the devices as much as possible. Data were collected at baseline, three weeks, six weeks, three months, and six months. Foot pain was assessed using an 11-point numerical rating scale (NRS). Foot pain and functionality were assessed using the foot pain and foot functionality sub-scales of the foot health status questionnaire (FHSQ). The global rating of change score (GROC) was provided at three weeks, six weeks, three months and six months to assess PF symptom change. A series of Wilcoxon signed-rank tests, Mann-Whitney U tests, Paired T-tests and independent sample t-tests were performed for analysis.
Foot pain scores significantly improved in both groups, as assessed and measured by the NRS and FHSQ pain sub-scale. Significant improvements in function by the FHSQ function subscale and changes in the level of symptoms by the GROC scale were also observed in both groups. The combined use of orthotics and orthotic sandals showed superior outcomes on all four measures but only reached statistical significance on the NRS pain scales.
This study provides evidence that both the combined use of orthotics and orthotic sandals and the sole use of orthotics alone, improve pain and function significantly in PF patients. Between-group differences show that the combined use does provide a greater decrease in foot pain compared to using orthotics alone.
Though this study provides evidence that the combined use of prefabricated orthotics and orthotic sandals improves foot pain in PF patients more than the use of prefabricated orthotics alone, it was not without limitation. Hence, future research should aim to address these limitations, including collecting data on participants’ duration of PF symptoms on enrolment, and risk factors for the condition.